Calcinosis cutis is the abnormal deposition of calcium phosphate into the skin. It is classified as dystrophic if the calcium is deposited in previously damaged tissue, and serum calcium and phosphorous levels are normal. We report a case of symmetric dystrophic calcinosis cutis on the both proximal arms of a 77-year-old woman who received a subcutaneous injection at each arm 30 years ago.
Aged ; Arm ; Calcinosis* ; Calcium ; Female ; Humans ; Injections, Subcutaneous* ; Skin

Background: Most studies of systematic drug repositioning have used drug-oriented data such as chemical structures, gene expression patterns, and adverse effect profiles. As it is often difficult to prove repositioning candidates’ effectiveness in real-world clinical settings, we used patient-centered real-world data for screening repositioning candidate drugs for multiple diseases simultaneously, especially for diabetic complications. Methods: Using the National Health Insurance Service-National Sample Cohort (2002 to 2013), we analyzed claims data of 43,048 patients with type 2 diabetes mellitus (age ≥40 years). To find repositioning candidate disease-drug pairs, a nested case-control study was used for 29 pairs of diabetic complications and the drugs that met our criteria. To validate this study design, we conducted an external validation for a selected candidate pair using electronic health records. Results: We found 24 repositioning candidate disease-drug pairs. In the external validation study for the candidate pair cerebral infarction and glycopyrrolate, we found that glycopyrrolate was associated with decreased risk of cerebral infarction (hazard ratio, 0.10; 95% confidence interval, 0.02 to 0.44). Conclusion To reduce risks of diabetic complications, it would be possible to consider these candidate drugs instead of other drugs, given the same indications. Moreover, this methodology could be applied to diseases other than diabetes to discover their repositioning candidates, thereby offering a new approach to drug repositioning.

Actinic keratoses (AK) are premalignant lesions, which can develop into invasive squamous cell carcinoma(SSC). Therapies for AK include cryotherapy, curettage, topical 5-fluorouracil, laser therapy and so forth. All therapies currently prescribed can be painful and may result in scarring and changes in skin pigmentation. A potential new treatment modality for AK is the imiquimod (Aldara(R)), which can be applied by patients themselves. We reported a case of AK which was very extensive on the scalp of the old man, who was treated with topical imiquimod.
Actins* ; Cicatrix ; Cryotherapy ; Curettage ; Fluorouracil ; Humans ; Keratosis, Actinic* ; Laser Therapy ; Scalp ; Skin Pigmentation

STUDY DESIGN: A retrograde study, using Computerized Tomography (CT), to evaluate a safer approaching angle and distance for a percutaneous endoscopic discectomy. OBJECTIVES: To measure the safest approaching angle and distance in a percutaneous endoscopic discectomy at each vertebra level in Koreans. LITERATURE REVIEW SUMMARY: Some authors have shown an approaching angle of between 25 to 30 degrees, but reports on Koreans patients are very rare. MATERIALS AND METHODS: 200 cases of abdomino-pelvic CT were investigated. The minimal angle of safe approach was composed of two lines, one horizontal line passing through the mid point in the posterior cortex of upper vertebra, with the other extending passed the mid point of posterior cortex in the upper vertebra to the dorsal margin of the retroperitoneal fat or peritoneum. The maximal distance for a safe approach was measured from the end of spinous process to the point where the extended former second line crosses the skin. The minimal angles and maximal distances for safe approaches in males and females, from the right and left sides, at each level of the intervertebral space and in groups according to the BMI were compared. RESULTS: Females had a larger mean minimal angle for a safe approach (14.7 degrees) than that for males (9.6 degrees). However, no differences were observed between the right (12.0 degrees) and left sides (12.4 degrees). At each vertebral level, L2-3(16.4 degrees), L3-4(11.3 degrees) and L4-5(8.8 degrees), significant differences were observed. However, obesity had no influence on the different angles for a safe approach. The maximal distances for safe approaches were 12.9 and 12,6cm in males and female, 12.8 cm in for both of the right and left sides, and 11.8, 13.0 and 13.6cm in L2-3, L3-4 and L4-5, respectively. No differences were observed in any of the above group, but the more obese group had a longer distance. CONCLUSIONS: Females and the upper level of the intervertebral space had larger minimal angles for a safe approach, but there were no differences in relation to gender, direction and obesity. All the maximal distances for safe approaches were the same in males, females, right and left, and at each level of the intervertebral space, but the more obese group had a longer distance. A safer zone for the approach in a percutaneous endoscopic lumbar discectomy can be taken, considering the gender, vertebra level and obesity.
Diskectomy* ; Female ; Humans ; Intra-Abdominal Fat ; Male ; Obesity ; Peritoneum ; Skin ; Spine

STUDY DESIGN: A retrograde study, using Computerized Tomography (CT), to evaluate a safer approaching angle and distance for a percutaneous endoscopic discectomy. OBJECTIVES: To measure the safest approaching angle and distance in a percutaneous endoscopic discectomy at each vertebra level in Koreans. LITERATURE REVIEW SUMMARY: Some authors have shown an approaching angle of between 25 to 30 degrees, but reports on Koreans patients are very rare. MATERIALS AND METHODS: 200 cases of abdomino-pelvic CT were investigated. The minimal angle of safe approach was composed of two lines, one horizontal line passing through the mid point in the posterior cortex of upper vertebra, with the other extending passed the mid point of posterior cortex in the upper vertebra to the dorsal margin of the retroperitoneal fat or peritoneum. The maximal distance for a safe approach was measured from the end of spinous process to the point where the extended former second line crosses the skin. The minimal angles and maximal distances for safe approaches in males and females, from the right and left sides, at each level of the intervertebral space and in groups according to the BMI were compared. RESULTS: Females had a larger mean minimal angle for a safe approach (14.7 degrees) than that for males (9.6 degrees). However, no differences were observed between the right (12.0 degrees) and left sides (12.4 degrees). At each vertebral level, L2-3(16.4 degrees), L3-4(11.3 degrees) and L4-5(8.8 degrees), significant differences were observed. However, obesity had no influence on the different angles for a safe approach. The maximal distances for safe approaches were 12.9 and 12,6cm in males and female, 12.8 cm in for both of the right and left sides, and 11.8, 13.0 and 13.6cm in L2-3, L3-4 and L4-5, respectively. No differences were observed in any of the above group, but the more obese group had a longer distance. CONCLUSIONS: Females and the upper level of the intervertebral space had larger minimal angles for a safe approach, but there were no differences in relation to gender, direction and obesity. All the maximal distances for safe approaches were the same in males, females, right and left, and at each level of the intervertebral space, but the more obese group had a longer distance. A safer zone for the approach in a percutaneous endoscopic lumbar discectomy can be taken, considering the gender, vertebra level and obesity.
Diskectomy* ; Female ; Humans ; Intra-Abdominal Fat ; Male ; Obesity ; Peritoneum ; Skin ; Spine

Erythema nodosum is a reactive dermatosis that occurs in response to various stimuli, such as bacterial, fungal and viral infections, drugs and malignancies. Lesions of erythema nodosum usually appear symmetrically on the extensor aspects of the legs with occasional involvement of the thighs or forearms. Unilateral or plantar involvement uncommonly occurs. A 26-year-old man presented with bilateral, painful, multiple, confluent, erythematous, firm nodules confined to the both plantar skin for 7 days. Histopathologic examination revealed fibrosis of and a lymphohistiocytic infiltrate within the septae of fat lobules, consistent with erythema nodosum. We, herein, report an unusual case of plantar erythema nodosum, which was successfully treated with nonsteroidal antiinflammatory drugs for 2 weeks.
Adult ; Erythema Nodosum* ; Erythema* ; Fibrosis ; Forearm ; Humans ; Leg ; Skin ; Skin Diseases ; Thigh

Acrometastasis is rare and accounts for 0.1% of all metastasis. Renal cell carcinoma accounts for only 10% of this infrequent site. It is usually the late manifestation of a disseminated tumor, but may also be the primary manifestation of an occult cancer. Clinically, it may mimic benign tumors or nonneoplastic osteoarthritic conditions, thus resulting in misdiagnosis and improper treatment. We reported a case of acrometastasis in a renal cell carcinoma in a 76-year-old man who had been diagnosed with a progressed renal cell carcinoma with metastasis of the lung and brain.
Aged ; Brain ; Carcinoma, Renal Cell* ; Diagnostic Errors ; Humans ; Lung ; Neoplasm Metastasis

We report a case of intradermal nevus in a 43-year-old female patient, who presented with a tender, solitary papule on the periungual area, which seemed to be a periungual fibroma. The skin biopsy revealed the upper dermis and lower dermis containing nests and cords of nevus cells without junctional activity. It was totally removed by excisional biopsy.
Adult ; Biopsy ; Dermis ; Female ; Fibroma* ; Humans ; Nevus ; Nevus, Intradermal* ; Skin

Seborrheic keratoses (SK) are very common benign tumor arising in epidermis. Few malignant transformation of SK were reported. Inflammation, ulceration or atypical nature is the evidence of malignant transformation. Some melanoma can mimic SK. So, all SK need confirm histopathologic diagnosis. We reported a case of recurrent seborrheic keratosis with satellite lesions on the left groin in a linear pattern in a 46-year-old man.
Diagnosis ; Epidermis ; Groin* ; Humans ; Inflammation ; Keratosis, Seborrheic* ; Melanoma ; Middle Aged ; Ulcer

Onychomycosis is the invasion of the healthy nail plate by species of dermatophytes, as well as a variety of non-dermatophytes (yeasts and moulds) which may cause nail infection, particularly after tissue damage by trauma or disease. Candida albicans and C. parapilosis are the most commonly isolated yeasts from abnormal toenails. The patient was a 20-year-old woman who presented with a thickened and crumbly nail plate of the right second finger for 4 months. Initially, a tiny yellowish macule appeared under the nail plate, which gradually involved the entire nail plate, resulting in complete deformity of the nail. She was diagnosed with diabetes mellitus 4 months ago and her blood sugar level was controlled with subcutaneous insulin injections. Direct microscopic examination of the scrapings prepared with potassium hydroxide revealed fungal elements. Repeated cultures on Sabouraud dextrose agar showed cream to white colored, semi-glossy, flat colonies, which were findings consistent with C. albicans. Complete extraction of the involved nail with meticulous curettage of the nail bed was made. She has been taking 150 mg of oral fluconazole weekly since August 2003 and showed substantial improvement.
Agar ; Arthrodermataceae ; Blood Glucose ; Candida albicans* ; Candida* ; Congenital Abnormalities ; Curettage ; Diabetes Mellitus* ; Female ; Fingers ; Fluconazole ; Glucose ; Humans ; Insulin ; Nails ; Onychomycosis* ; Potassium ; Yeasts ; Young Adult